Healthcare Provider Details

I. General information

NPI: 1861452294
Provider Name (Legal Business Name): JOSEPH J SLIWKOWSKI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOUNT ROYAL AVE
MARLBOROUGH MA
01752-1981
US

IV. Provider business mailing address

5 MOUNT ROYAL AVE
MARLBOROUGH MA
01752-1981
US

V. Phone/Fax

Practice location:
  • Phone: 508-251-7262
  • Fax: 508-251-7265
Mailing address:
  • Phone: 508-251-7262
  • Fax: 508-251-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01051636A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number01051636A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number74311
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: